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Robotic Thoracic Surgery: Current Landscape and Future Directions.

Akshay J Patel1,2, Kazuhiro Yasufuku1, Andrea Bille3,4

  • 1Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON M5G 2C4, Canada.

Interdisciplinary Cardiovascular and Thoracic Surgery
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Summary

Robotic-assisted thoracic surgery (RATS) offers oncological equivalence to VATS, with potential for improved lymph node yield. Future RATS adoption requires structured training, equitable access, and further validation for patient-centered care.

Keywords:
robotic-assisted thoracic surgery (RATS)single-port robotic platforms (SP)surgical training and education

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Area of Science:

  • Minimally Invasive Surgery
  • Thoracic Surgery
  • Surgical Technology

Background:

  • Robotic-assisted thoracic surgery (RATS) is now a staple in minimally invasive thoracic procedures.
  • Advancements in multi-platform systems, single-port (SP) technology, and artificial intelligence (AI) are driving innovation in surgical precision and patient-specific approaches.

Purpose of the Study:

  • To evaluate the current status, benefits, limitations, and future direction of RATS.
  • To synthesize evidence from randomized controlled trials (RCTs), observational studies, and technological innovations.

Main Methods:

  • Evidence synthesis from RCTs (RVlob, ROMAN, RAVAL-4), national training surveys (SORTS UK), comparative thymic resection series, and SP platform feasibility studies.
  • Assessment of technological innovations including AI-driven analytics and SP systems.

Main Results:

  • RCTs show oncological equivalence between RATS and video-assisted thoracoscopic surgery (VATS), with potential for higher lymph node yield.
  • Structured training is crucial for RATS adoption, and SP platforms show feasibility in high-volume centers but face adoption barriers.
  • AI in surgical planning and navigation shows promise, but cost, access, and reproducibility remain challenges.

Conclusions:

  • RATS is evolving towards precision oncology, less invasive techniques, and data-driven surgical intelligence.
  • Realizing the full potential of RATS necessitates further comparative research, equitable access, and integration into standardized training programs for global adoption.